P1251328620LFOjH - PowerPoint PPT Presentation
1 / 44
Title:
P1251328620LFOjH
Description:
Diet. Exercise. Counseling. Weight loss programs. Jenny Craig, Weight Watchers, etc. 6 ... Reduces healthcare costs for patients. Improves overall quality of ... – PowerPoint PPT presentation
Number of Views:98
Avg rating:3.0/5.0
Title: P1251328620LFOjH
1
Surgical Weight Loss
Information Seminar
2
Obesity
- Obesity has become an epidemic
- Over 36 of the population of the state of Texas
is morbidly obese - Since 1980, the incidence of morbid obesity has
quadrupled - Obesity is now the second leading cause of
preventable death in the U.S.
3
Obesity
- Responsible for approximately 500,000 deaths
per year - 14 of all cancer deaths in men
- 20 of all cancer deaths in women
3
4
Obesity
- Historically poorly defined
- Old definition Greater than 100 lbs. over
ideal body weight - Very difficult to compare scientific studies
across the country / world
4
5
Obesity
- Current definition
- Body Mass Index (BMI)
- Weight (Kg) / Height (m2)
- Normal 20 - 25
- Obese 25 - 35
- Morbidly Obese 35 - 50
- Super morbid obesity 50
5
6
Weight Loss Options
- Diet
- Exercise
- Counseling
- Weight loss programs
- Jenny Craig, Weight Watchers, etc.
6
7
Weight Loss Options
- Old mentality
- Gland Problem
- Lack of willpower
- Eating disorder
- Recognize ADDICTION in a large number of cases
7
8
Weight Loss Options
- Dieting
- Extremely prominent in the media
- Notable absence of discussion of long-term
results - From a medical standpoint, dieting alone is
almost uniformly ineffective in this patient
population - Patients typically regain all lost weight over
their next five years - Recent study Final average weight loss of only
three pounds
8
9
Dieting
- Define long-term success
- Realize that by this definition, 98 of diets
ultimately fail - Consequences of failure
- Depression, anxiety, irritability
- Decrease in overall quality of life
- Understand why diets fail
9
10
Dieting
- Reasons for failure
- Hunger
- Hunger
- Hunger
- Hunger
- Hunger
- Hunger
10
11
Grehlin
- Understand the mechanism of satiety in the human
brain - Grehlin
- Naturally produced hormone discovered shortly
after the year 2000 - Produced in the stomach in response to a lack of
food - Acts in the brain by causing a feeling of satiety
11
12
Grehlin
12
13
Grehlin
13
14
Grehlin
14
15
Grehlin
15
16
Grehlin Levels
- Essentially, gastric bypass equates to less
hunger - Greater degree of success with weight loss after
gastric bypass due to this mechanism - Higher compliance with post-op diet regimen due
to this as well as positive reinforcement due to
notable weight loss
16
17
Medical Co-morbidities
- Metabolic
- Degenerative
- Psychological
- Neoplastic
17
18
Metabolic Co-morbidities
- Type II Diabetes
- Hypertriglyceridemia
- Hypercholesterolemia
- Fatty infiltration of the liver
- Hypertension
18
19
Degenerative / Anatomic
- DJD
- Sleep apnea
- Congestive heart failure
- Stress urinary incontinence
- GERD
- Long-term consequences of diabetes
- Renal failure, stroke, amputation, etc.
19
20
Psychological
- Anxiety disorders
- Depression
- Social avoidance
20
21
Neoplastic
- Breast
- Uterine
- Gastric
- Esophageal
- Pancreatic
- Hepatic
- Note Risk increases markedly at BMI 30-35
21
22
Consequences
- Diminished quality of life
- Early death
- JAMA Jan 2003 study
- Example White male over 40 yrs old with BMI gt
40 will experience a 22 reduction in remaining
life span
22
23
Who is a Surgical Candidate
- BMI of 35 or over with any co-morbidity
- BMI of 40 or greater
- Traditionally, age 18 to 60 years old
- Non-endocrine related cause of obesity
- Patients dedicated to permanent lifestyle changes
and long-term follow-up
23
24
Who is NOT a Surgical Candidate?
- Active substance abusers
- Noncompliant patients
- Patients with severe psychiatric disorders
- Schizophrenia
- Severe depression
- Borderline personality disorder
24
25
Surgical Options
- Restrictive
- Lap-Band
- VBG
- Sleeve Gastrectomy
- Malabsorptive
- J-I Bypass
- Combination
- Roux-en-y bypass
- Biliary pancreatic diversion / duodenal switch
25
26
Surgical Options
- Vertical Banded Gastroplasty
26
27
Surgical Options
- Lap-Band
27
28
Surgical Options
- Sleeve Gastrectomy
28
29
Surgical Options
Click to edit Master title style
- Biliopancreatic Diversion
- Click to edit Master text styles
- Second level
- Third level
- Fourth level
- Fifth level
29
29
30
Surgical Options
- Roux-en-Y Gastric Bypass
30
31
Realistic Expectations
- Weight loss surgery is not a cure
- Surgery should be viewed as a tool to help with
weight loss
31
32
Risks and Complications
- Lap-Band
- Infection
- Erosion
- Slip
- Damage to stomach while placing band
32
33
Risks and Complications
- Sleeve gastrectomy
- Leak
- Nausea
- Possible need for bypass in future
33
34
Risks and Complications
- Gastric bypass
- Long-term
- Weight regain
- Anemia
- Vitamin / mineral deficiency
34
35
Risks and Complications
- Gastric bypass
- Short-term
- Wound infection
- Hernia
- Pneumonia
- Heart attack
- Bleeding
- Blood clots (pulmonary embolism)
- Stricture
- Dumping syndrome
35
36
Risks and Complications
- Gastric bypass
- Short-term
- Gallstones
- Hair loss
- Dietary intolerance
- Peripheral neuropathy
- Fistula
- Leak
- Death
36
37
Risks and Complications
- Death from gastric bypass
- Most common cause is from pulmonary embolism
- Leaks play a major role as well
- Risk of death from gastric bypass across the
country is 0.5 - Realize that gastric bypass reduces the mortality
of morbidly obese patients by 89 over a
five-year period when compared with morbidly
obese patients who do not undergo significant,
sustained weight loss
37
38
Expectations
- Active aftercare participation
- Long-term follow up
- Daily vitamin supplementation after bypass
- Weekly B12 supplementation after bypass
- Band fills after Lap-Band
38
39
Which Option Should I Choose?
- Patient choice
- IMPORTANT
- Lap-Band
- Technically lower risk
- On average 36-40 excess weight loss at one year
- Average of 60-65 excess weight loss at 3-5
years - Slower resolution of co-morbidities
- Importance of ongoing need for band fills for
6-12 months - Reversible
- Importance of realistic expectations
39
40
Which Option Should I Choose?
- Sleeve gastrectomy
- Lower risk than gastric bypass
- Higher risk than Lap-Band
- Long- and short-term weight loss between Lap-Band
and gastric bypass - No dumping syndrome
- No need for band fills
40
41
Which Option Should I Choose?
- Gastric bypass
- Technically higher risk
- On average 70-80 excess weight loss at one year
- Faster resolution of co-morbidities
- Non-reversible
41
42
Conclusion
- Surgically induced weight loss
- Improves or resolves co-morbidities
- Decreases risk of early death from wide variety
of causes - Decreases risk of developing obesity related
illnesses - Reduces healthcare costs for patients
- Improves overall quality of life
42
43
What Next?
- Generate Letter of Medical Necessity to
insurance carrier - Understand many insurance carriers are difficult
to obtain approval from - After response, schedule consult
- Schedule any necessary pre-op tests
- Surgery
- Post-op dietician consult
- Post-op physical therapy / exercise program
- Optional behavioral modification counseling
- Weekly / monthly support group meetings
- Follow-up at 2 wks, 6 wks, 6 mos, yearly
43
44
Questions
44
Recommended
CrystalGraphics Presentations
